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General NPI Number Information
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NPI Number | 1619934676
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Entity Type | Organization
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Legal Business Name | BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1127 CARNEGIE AVE
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City | CLEVELAND
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State | OH
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Zip | 44115-2805
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Country | US
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Telephone | 216-861-4246
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Fax | 216-861-1156
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Provider Business Mailing Address
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Address Line | 1127 CARNEGIE AVE
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City | CLEVELAND
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State | OH
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Zip | 44115-2805
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Country | US
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Telephone | 216-861-4246
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Fax | 216-861-1156
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LEONARD CHARLES LEE COLLINS
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Credential | OCPS II
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Telephone | 216-861-4246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 020263800
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License Number State | OH
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